Metzitzah B’Peh Under Scrutiny Again


babycribMetzitzah b’peh as it has been practiced b’mesorah for centuries is under scrutiny again – this time in the frum community. The latest installment of the “bris milah patrol” was written by Rabbi Avi Billet in the pages of The Jewish Star. While the article is not intentionally disparaging of metzitzah b’peh or bris milah in general – after all, it was written by an actual mohel of 10 years – certain aspects of it are eerily reminiscent of the attacks on bris milah in New York City just a few years ago and a campaign to vilify a respected and expert mohel. A number of the statements in the article would lead one to believe that virtually all mohelim are negligent in one way or another in ensuring the sterility of the instruments they use and in doing everything in their power to protect the babies who they bring into the covenant of Avrohom Avinu.

Regarding metzitzah, the article states:

“Metzitzah” is defined as drawing “deeper” blood from the circumcision spot, which some view as a medical necessity while others view it, based on modern medical knowledge, as a ritualistic remnant of what may have once been deemed a medical requirement (Shabbat 133a-b).

The article then unabashedly rejects the practice of metzitzah b’peh, stating, “Both [metzizah b’peh and metzizah with an instrument] are halachically sanctioned, while only one [metzizah with an instrument] meets the approval of any unbiased modern medical sensibility.” 

The article, in its entirety, is as follows:

Relative to other surgeries, bris milah is a simple procedure, with a surprisingly low risk rate. At the same time, an incision, an open wound and the removal of skin tissue necessitate precautions which will minimize danger to the child. The parents and the mohel must be on the same page on this latter point.

In an operating room, a surgeon takes many precautions to minimize the chance of bacterial infection reaching the patient. Mohels should be held to these same standards when operating on infant boys. It is understood, of course, that the public nature of the ceremony makes complete sterility an impossibility. Nonetheless, we are a far cry from where standards should be.

The sterility litmus test can be broken down to five components: how instruments are sterilized, how they are laid out for bris use, how the mohel cleans his hands, whether sterile gloves are worn when dealing with the open wound and how metzitzah is done.

Surgeons sterilize packaged instruments in a machine at 273° Fahrenheit, and avoid opening the “sterility guaranteed” package until surgery time. Mohels should do the same. Cold sterilization in a solution or in rubbing alcohol is less than ideal, and the five minute soaking some mohels employ before the bris is substandard. It may produce a nice alcohol aroma, but real cold sterilization requires hours of soaking to be completely effective.

Instruments laid out on a freshly laundered diaper cloth may be quite comfortable, but they have lost any claim of sterility. A pre-packaged sterile drape is easily accessible and should be standard for every mohel to use.

A mohel who washes his hands and is careful not to shake others’ hands should be commended. But when he adjusts his pants, head-covering, lab coat or tallis, not to mention his instrument bag or a bottle of wine while laying out instruments, he has negated any previous hand washing.

Some mohels will operate with bare hands “sterilized” by alcohol or Purell. Nice as this is, touching the pillow, baby, sandak, and baby’s diaper make previous efforts meaningless. Additionally, it is virtually impossible to completely clean under the fingernails, unless (with a big ‘perhaps’) the mohel soaks in a chlorinated pool for 20 minutes immediately before the bris. This is an uncommon practice.

Mohels should be required to wear sterile gloves, donned immediately before touching sterile instruments and the sterile field of the bris. If it is time consuming, he can wear two pairs, removing the outer pair immediately prior to beginning. Non-sterile gloves are a step up from “no gloves,” but they are still less than ideal.

“Metzitzah” is defined as drawing “deeper” blood from the circumcision spot, which some view as a medical necessity while others view it, based on modern medical knowledge, as a ritualistic remnant of what may have once been deemed a medical requirement (Shabbat 133a-b).

Over time the idea of doing metzitzah with the power of the mouth was introduced, which is defined in two ways: either put a mouth directly on the wound, or use the power of the mouth through a sterile pipette. The latter avoids direct contact and the sharing of body fluids between mohel and baby.

Both are halachically sanctioned, while only one meets the approval of any unbiased modern medical sensibility. Arguments such as “saliva heals” and “one’s first instinct is to suck a cut on your finger” are irrelevant to the case of a mohel’s mouth touching a fresh wound in a newborn.

Any parent who insists that metzitzah be done with direct oral contact should do the metzitzah himself.

Maimonides writes, “It is impossible to restore the lost life of a Jewish child” (Milah 1:18). While he says this to allow delaying a bris on a child who is not physically ready, certainly the same dictum should be followed when circumcising a child: no step in the bris procedure should allow the slightest possibility that its inclusion can open the door to giving the baby an infection.

It is our responsibility and right to demand the best for our children. For the sake of the health of our children, let us begin with insistence that the bris maintains the highest standards of sterility.

High standards of sterility for a bris

When the following precautions are taken, the possibility of infection is reduced to the smallest percentage.

  • All instruments, drapes and bandages are completely sterile
  • The sandak, who holds the baby during the bris, does not touch the baby directly. Baby’s legs are covered with a blanket or wrapped with a conform bandage.
  • Mohel wears sterile gloves for the bris and every time he touches the baby’s open wound thereafter
  • When metzitzah is done, there is no direct bodily contact between mohel and baby
  • No one who is ill participates in the bris ceremony
  • Those who care for the wound after the bris wash hands with soap and water before opening the diaper
  • After bandage is removed, anti-infection ointment, such as bacitracin, is applied to the healing wound for a few days

{The article from the Jewish Star can be read here.}

{Dovid Newscenter}




  1. Did you ever try to use a scalpel with gloves on?

    Personally, I would rather have the feel of bare hands, along with the extrememly slight risk on infection. Better to need an antibiotic than have an accident because of poor “feel” due to the gloves. Yes, I know surgeons use gloves all the time. But their training and experience is different. Plus they have no choice. They also do it for their own protection.

    Secondly, Metzitza needs to be directly with the mouth, according to many poskim.

  2. This is not a threat. This is a know it all shnook who is coming out against gedolei umanhigei klal yisroel.

    Normally we call this a chutzpah !!

  3. Surgeons use sterile gloves that are paper thin. They are not the regular, thicker gloves we are all used to seeing or using. That said, bris mila is a Torah commandment. It’s been done the same way for millenia. Considering the millions of brissim performed throughout our history, many under the most primitive of conditions, the percentage of post mila complications is infinitessimal. Even with all the sterilized instruments and operating rooms, and all the other precautions taken by modern hospitals, infections can and do occur.
    What these so called experts are doing is nothing more than trying to alter our mesorah. Quite honestly, they should all be put in cherem. The bright side is they’ll all have to answer for their actions after 120 years. Then will see who has the last laugh.

  4. Edinburgh Medical Journal 2 (1856-57) #555
    “Syphilitic and cancerous ulcers may also infect the child through the bleeding wound. Rust has related the case of a circumciser who had syphilitic ulcers of the mouth, who infected four children in the manner.”

    Pediatrics, Volume XXXIV, Page 186-190, March 1917
    “Tuberculosis Following ritual Circumcision” by Mark S. Reuben
    “A review of he literature shows that there are 42 cases (including our case) of tuberculosis infection following ritual circumcision. The incidence of such infection must have been greater and many cases have probably not been reported. It seems reasonable to suppose that the same operator (mohel) would probably infect a majority of the infants on whom he performed circumcision…
    In 37 cases the wound was sucked in the usual way; in 3 the wound was sprinkled with wine from the mouth of the operator; in one case a dressing was applied to the wound on which wine from the mouth of the operator was poured on; in our case the wound was aspirated through a glass tube….
    Of the 42 cases reported, 11 recovered, 16 died, and of 15 the final outcome is not known…”

    Earliest reference to Oral MBP in in Rav Yaakov Hagozer (12th century) who writes
    ??? ?????? ??? ????? ???? ???? ??? ????? ?? ??? ??? ???? ???? ???? ???? ??? ???? ????? ??? ?? ???? ????…

    I challenge anyone to find a legitimate earlier source for MBP orally.
    I challenge anyone to prove that “brisses for millennia” were risk free.
    I submit that until recently infantile deaths were accepted as normal and people did not report them, and things have only changed BECAUSE of modern notions of sterility.

    Even if you study the words I’ve quoted above, you see Rav Yaakov Hagozer’s definition of MBP is purely medical. And as medical science is different now, his definitions are not relevant.

    As a matter of fact, anyone who believes and follows ancient medical science can not be considered a shomer halakha, and is probably a closet Scientologist, or one of those extreme religious sects (non-Jewish) which does not believe in medicine.

    I’ve brought REAL information. Not speculation. Not hyperbole. Not “my gut feeling” because “I believe be’emunah shleimah that the author of the article is a kofer” but because I believe beemunah shleimah that those who mudsling the good name of a good Jew need to be put in their place.

    I am not arguing there is no place for MBP. Like Rabbi Billet, however, I believe there are two ways to look at things. And you have to remove your blinders. Because the way you have them on, it’s a wonder how you see anything at all.

  5. After all is said & done, fatality rates are much higher even in the best hospitals than for those receiving a traditional Bris Milah including metzitzah b’peh.

  6. There is something else here, people.
    There are gentiles, and maybe “jews” who claim to be “Libertarians”–all espesially for the Bill of Rights.
    But have you heard any of them defending HaTzaddik Reb Yitzchok Aron Fisher shlita during his travails 4 years ago?
    What about criminal attempt by the L.A./Hollywood degenerates to…imprison Kvod Kdushas Admor M’Spinka?
    BTW, when I demanded that Lakewood women start chain-calling(their favorite) White House and DOJ, head of a news website told me in e-mail that he believes Hollywooders…
    Who “Libertarians” attack with ferocity are “neocons”, code word for the “Jews”.
    Scratch “Libertarian”, or “Constitutionalist” and get a Nazi…

  7. It comes as no surprise that the author is student of Dr. Moshe Dovid Tendler who has led a forty year crusade to oust chareidi mohelim from NYC. Beginning with his Mt Sinai School of circumcision in 1968, which introduced a new prerequisite to be a mohel, one needed to be a college graduate(not necessarily from a theological seminary,)(NYT 3/19/68 p.51) to the use of the brith milah board of NY as a proxy to prevent mohelim that did metzitzah from entering NYC hospitals, to his slander of a respected mohel during his lecture on Dec 12, 2004: “The man is under investigation now for infecting several children, two of whom died” Only one child in fact had died and this comment was made while the investigation was in it’s infancy long before any conclusion had been reached; to his publication of four articles attacking metzitzah. Although his name only appears on two of them, the first is by his colleague at Albert Einstein, Dr Lorry Rubin, the second, possibly written by Lorry Rubin as well, was published by Rubin’s long time acquaintance Dr. Benzion Garty. This group of 22 doctors who have never done a paper on neonatal herpes, 17 of whom have never even done a paper on herpes, 6 of whom signed onto a finished paper and weren’t even authors, link 11 cases of HSV-1 to MBP using the most absolutelty absurd criteria and then fail to perform any standard test that would either implicate the mother or exonerate the mohel. Having just completed what might be the most intensive review of the literature on neonatal herpes ever undertaken I was shocked to find the authors consistantly fail to disclose information in their own refernces confirming their cases as textbook maternally transmitted herpes, they cite sources and then write the opposite, they cite sources that have nothing to do with the topic, and they manipulate their testing methods to make sure there is no result contrary to their predetermined conclusion. The NYC Dept of Health, displays a wealth of ignorance and actually contradict some of their own published material on the subject. Ignoring 30 years of neonatal herpes research they follow the authors’ path and fail to perform any test that might have a conclusive result, relying on statistical conclusions to implicate the Mohel. My personal interviews confirm that one of the Mohelim who was told he was seropositive and likely the source was retested 3 times and found to be seronegative. Another mohel was clearly lied to as indicated in the authors’ own description of his case. A full report will be available in the next few weeks.